All Reproductive Health

According to the United States Medical Eligibility Criteria for Contraception Use, indicate the appropriate US MEC category for a 33-year-old woman with family history of breast cancer in a second-degree relative for a Cu-IUD or LNG-IUD. A. Category 1 B. Category 2 C. Category 3 D. Category 4

A. Category 1

The use of combined oral contraception (COC) reduces menstrual volume by approximately 60%, thereby reducing the risk of iron deficiency anemia. A. True B. False

A. True

Irregular bleeding associated with DMPA (Depo-Provera®) can be minimized with the use of all of the following except: A. acetaminophen. B. ibuprofen. C. naproxen sodium. D. estrogen supplements

A. acetaminophen.

When can a woman safely conceive after discontinuing COC or LARC use? A. immediately B. after 1 to 2 months C. after 3 to 4 months D. after 5 to 6 months

A. immediately

Which of the following is not part of the criteria for an older woman to cease having any future Pap tests performed? A. older than 55 years of age B. negative screening results on three consecutive cytology or two consecutive co-test results within 10 years C. the most recent cytology occurring within the past 5 years D. no history of cervical intraepithelial neoplasm (CIN) 2 or greater within the past 20 years

A. older than 55 years of age

A 22-year-old woman taking a 35-mcg ethinyl estradiol COC calls after forgetting to take her pills for 2 consecutive days. She is 2 weeks into the pack. You advise her to: A. take the last pill missed immediately, even if this means taking two pills today. B. discard two pills and take two pills today. C. discard the rest of the pack and start a new pack with the first day of her next menses. D. continue taking one pill daily for the rest of the cycle.

A. take the last pill missed immediately, even if this means taking two pills today.

A transvaginal ultrasound in the woman with PID will likely show: A. tubal thickening with or without free pelvic fluid. B. cervical thickening. C. endometrial thinning. D. inflammation of the ovaries.

A. tubal thickening with or without free pelvic fluid.

Which body area has the greatest concentration of estrogen receptors? A. vulva B. vascular bed C. heart D. brain

A. vulva

The average age of menopause in the United States is A. 45 years. B. 48 years. C. 50 years. D. 53 years.

Answer C - 50 years. The average age of menopause in the United States is 50 years. Menopause is defined by the World Health Organization as the permanent cessation of menstruation resulting from loss of ovarian follicular activity and 12 months of amenorrhea at the time of midlife.

Nausea with COC use can be minimized by taking the pill on an empty stomach. A. True B. False

B. False

A 26-year-old mother who breastfeeds her 4-month-old child queries about hormonal contraceptives. In counseling her on the use of the progestin-only pill (POP), you mention all of the following except: A. the pill is taken every day. B. POP is a more effective contraceptive than COC. C. POP does not alter the quality or quantity of breast milk. D. POP is associated with bleeding irregularity, ranging from prolonged flow to amenorrhea.

B. POP is a more effective contraceptive than COC.

Due to an increased risk of blood clots, an alternative to the contraceptive ring (NuvaRing®) or patch (Ortho Evra®) is preferred in all of the following women except: A. a 42-year-old nulliparous woman with type 2 diabetes mellitus and high LDL. B. a 31-year-old woman with a history of naturally occurring multiple gestation pregnancy. C. a 28-year-old who smokes >15 cigarettes per day. D. a 33-year-old with a family history of venous thrombosis.

B. a 31-year-old woman with a history of naturally occurring multiple gestation pregnancy.

The reduction in free androgens noted in a woman using COC can yield an improvement in: A. cycle control. B. acne vulgaris. C. breast tenderness. D. rheumatoid arthritis.

B. acne vulgaris.

Which of the following is likely not among the proposed mechanisms of action of all forms of oral emergency contraception? A. inhibits ovulation B. acts as an abortifacient C. slows sperm transport D. slows ovum transport

B. acts as an abortifacient

According to the United States Medical Eligibility Criteria (US MEC) for Contraception Use, which of the following is a clinical condition in which the use of a copper-containing intrauterine device (Cu-IUD) or levonorgestrel-releasing IUD (LNG-IUD) should be approached with caution? A. uncomplicated valvular heart disease B. current pelvic inflammatory disease C. hypertension D. dysmenorrhea

B. current pelvic inflammatory disease

With DMPA in depot injection (Depo-Provera®), the recommended length of use is usually: A. less than 1 year. B. no more than 2 years. C. as long as the woman desires this form of contraception. D. as determined by her lipid response to the medication.

B. no more than 2 years.

By using a diaphragm with spermicide nonoxynol-9 during sexual intercourse, a woman is likely at increased risk for: A. cervical stenosis. B. urinary tract infection. C. increased perivaginal lactobacilli colonization. D. ovarian malignancy.

B. urinary tract infection.

As you prescribe COC containing the progestin drospirenone (Loryna™, Ocella®, Vestura®, Yasmin®, Yaz®), you offer the following advice: A. "Always take this pill on a full stomach." B. "You should not take acetaminophen when using this birth control pill." C. "Avoid using potassium-containing salt substitutes." D. "You will likely notice that premenstrual syndrome symptoms might become worse."

C. "Avoid using potassium-containing salt substitutes."

Which of the following is the most appropriate response to a 27-year-old woman who is taking phenytoin (Dilantin®) for the treatment of a seizure disorder and is requesting hormonal contraception? A. "A barrier method would be the preferable choice." B. "COC is the best option." C. "Depo-Provera® (medroxyprogesterone acetate in a depot injection [DMPA]) use will likely not interact with your seizure medication." D. "Cu-IUD or LNG-IUD use is contraindicated."

C. "Depo-Provera® (medroxyprogesterone acetate in a depot injection [DMPA]) use will likely not interact with your seizure medication."

The most likely causative pathogen in a 23-year-old woman with PID is: A. E. coli. B. Enterobacteriaceae. C. C. trachomatis. D. Pseudomonas

C. C. trachomatis.

Which of the following women is the best candidate for progestin-only pill (POP) use? A. an 18-year-old woman who frequently forgets to take prescribed medications B. a 28-year-old woman with multiple sexual partners C. a 32-year-old woman with adequately controlled hypertension D. a 26-year-old woman who wants to use the pill to help "regulate" her menstrual cycle

C. a 32-year-old woman with adequately controlled hypertension

Which of the following is a treatment option for a 28-year-old woman with PID who has no history of medication allergy and has undergone a bilateral tubal ligation? A. ofloxacin with metronidazole B. gentamicin with cefpodoxime C. ceftriaxone with doxycycline D. clindamycin with azithromycin

C. ceftriaxone with doxycycline

Noncontraceptive benefits of COC use include a decrease in all of the following except: A. iron-deficiency anemia. B. pelvic inflammatory disease (PID). C. cervicitis. D. ovarian cancer.

C. cervicitis

Expected laboratory findings for the woman with PID include all of the following except: A. elevated erythrocyte sedimentation rate (ESR). B. elevated C-reactive protein (CRP). C. elevated creatinine clearance (CrCl). D. leukocytosis.

C. elevated creatinine clearance (CrCl).

Physical examination of a 19-year-old woman with a 3-day history of vaginal itch reveals moderate perineal excoriation, vaginal erythema, and a white, clumping discharge. Expected microscopic examination findings include: A. a pH greater than 6.0. B. an increased number of lactobacilli. C. hyphae. D. an abundance of white blood cells.

C. hyphae.

A 22-year-old woman complains of pelvic pain. Physical examination reveals cervical motion tenderness and uterine tenderness. Which of the following would further support a diagnosis of PID? A. temperature less than 100°F (37.8°C) B. absence of white blood cells in vaginal fluid C. mucopurulent vaginal discharge D. laboratory documentation of cervical infection with Escherichia coli

C. mucopurulent vaginal discharge

Which of the following is a contraindication to estrogen/progestin-containing methods (combined oral contraception [COC], patch [Ortho Evra®], or ring [NuvaRing®])? A. mother with a history of breast cancer B. personal history of hepatitis A at age 10 years C. presence of factor V Leiden mutation D. cigarette smoking one pack per day in a 22-year-old

C. presence of factor V Leiden mutation

When considering the use of etonogestrel subdermal implant (Nexplanon®) for contraception, the NP realizes that: A. three rods are placed under the skin. B. this method provides effective contraception for up to 2 years. C. this method can lose effectiveness over time in overweight or obese women. D. this method is considered acceptable for select women with a history of thrombophilia forms.

C. this method can lose effectiveness over time in overweight or obese women.

Examples of phytoestrogens include all of the following except: A. red clover. B. ginseng. C. vitamin E. D. soy products

C. vitamin E.

Which of the following statements is false? A. Progestin-only emergency contraception can be taken as one dose or two doses. B. Ulipristal is available by prescription only. C. Progestin-only emergency contraception is usually available without prescription. D. Ulipristal is taken in two doses 12 hours apart

D. Ulipristal is taken in two doses 12 hours apart

Findings in estrogen deficiency (atrophic) vaginitis include: A. a malodorous vaginal discharge. B. an increased number of lactobacilli. C. a reduced number of white blood cells. D. a pH greater than 5.0.

D. a pH greater than 5.0.

Which of the following include characteristic s of a friable cervix? A. presence of a dull pain, particularly prior to menses B. a constant burning sensation C. presence of multiple polyps D. easily irritated and prone to bleeding, especially following intercourse

D. easily irritated and prone to bleeding, especially following intercourse

A 24-year-old woman who requests emergency contraception in oral form wants to know the effects if pregnancy does occur. You respond that there is the risk of increased rate of: A. spontaneous abortion. B. birth defects. C. placental abruption. D. none of the above.

D. none of the above.

Treatment options for bacterial vaginosis include all of the following except: A. oral metronidazole. B. clindamycin cream. C. oral clindamycin. D. oral azithromycin.

D. oral azithromycin.

When counseling a woman about COC use, you advise that: A. long-term use of COC is discouraged because the body needs a "rest" from birth control pills from time to time. B. fertility is often delayed for many months after discontinuation of COC. C. there is an increase in the rate of breast cancer after protracted use of COC. D. premenstrual syndrome symptoms are often improved with use of COC.

D. premenstrual syndrome symptoms are often improved with use of COC.

A 38-year-old nulliparous woman who smokes two and a half packs a day is in an "on-and-off" relationship. The woman presents seeking contraception. Which of the following represents the most appropriate method? A. contraceptive ring (NuvaRing®) B. COC C. contraceptive patch (Ortho Evra®) D. vaginal diaphragm

D. vaginal diaphragm

Which of the following is not a normal finding in a woman during the reproductive years? A. vaginal pH of 4.5 or less B. Lactobacillus as the predominant vaginal organism C. thick, white vaginal secretions during the luteal phase D. vaginal epithelial cells with adherent bacteria

D. vaginal epithelial cells with adherent bacteria

A woman who has used any form of oral emergency contraception should be advised that if she does not have a normal menstrual period within ______ weeks, a pregnancy test should be obtained. A. 1 to 2 B. 2 to 3 C. 3 to 4 D. 4 to 5

C. 3 to 4

A 45-year-old woman just had a normal Pap test result and has an absence of high-risk HPV. You recommend her next Pap test in: A. 1 year. B. 3 years. C. 5 years. D. 7 years.

C. 5 years.

Which of the following statements is true concerning vaginal diaphragm use? A. When the device is in place, the woman is aware that the diaphragm fits snugly against the vaginal walls. B. This is a suitable form of contraception for women with recurrent urinary tract infection. C. After the device is inserted, the cervix should be smoothly covered. D. The device should be removed within 2 hours of coitus to minimize the risk of infection.

C. After the device is inserted, the cervix should be smoothly covered.

According to the United States Medical Eligibility Criteria (US MEC) for Contraception Use, indicate the appropriate US MEC category for a 29-year-old woman with PID for combined hormonal contraceptives (i.e., combined oral contraceptive, patch, or vaginal ring). A. Category 1 B. Category 2 C. Category 3 D. Category 4

A. Category 1

According to the United States Medical Eligibility Criteria for Contraception Use, indicate the appropriate US MEC category for a 25-year-old woman with adequately controlled hypertension for a Cu-IUD or LNG-IUD. A. Category 1 B. Category 2 C. Category 3 D. Category 4

A. Category 1

According to the United States Medical Eligibility Criteria for Contraception Use, indicate the appropriate US MEC category for a 33-year-old woman who smokes two packs per day for a Cu-IUD or LNG-IUD. A. Category 1 B. Category 2 C. Category 3 D. Category 4

A. Category 1

Which of the following statements is true? A. Many over-the-counter progesterone creams contain sterols that the human body is unable to use. B. All progesterones are easily absorbed via the skin. C. Alfalfa is an example of a phytoprogesterone. D. Progesterones, whether synthetic or plant-based, should not be used by a woman who has undergone a hysterectomy.

A. Many over-the-counter progesterone creams contain sterols that the human body is unable to use.

Which of the following drugs may have their effects enhanced when used in combination with an oral contraceptive? A. Beta blockers B. Oral anticoagulants C. Antacids D. Anti-convulsants

Answer A - Beta blockers The effects of beta blockers, as well as the effects of alcohol, corticosteroids, theophylline, and diazepam (Valium), may be enhanced when they are used in combination with oral contraceptives. Other drugs whose effects may be enhanced when used in combination with an oral contraceptive include tricyclic antidepressants and some benzodiazepines.

n contrast to progestin-only emergency contraception, a possible mechanism of action of ulipristal (ella®) is: A. inhibiting embryo implantation. B. impairing sperm transport. C. through spontaneous abortion. D. impairing ovum transport.

A. inhibiting embryo implantation.

Which of the following is a treatment option for a 30-year-old woman with PID and a history of severe hive-form reaction when taking a penicillin or cephalosporin? A. ofloxacin with metronidazole B. amoxicillin with gentamicin C. cefixime with vancomycin D. clindamycin with azithromycin

A. ofloxacin with metronidazole

Which of the following is commonly found after 1 year of using DMPA (Depo-Provera®)? A. weight gain B. hypermenorrhea C. acne D. rapid return of fertility when discontinued

A. weight gain

Which of the following is an indication for a colposcopy? A. A Pap smear showing dysplasia B. Recurrent STIs C. HIV infection D. History of leiomyomas

Answer A - A Pap smear showing dysplasia Indications for a colposcopy include a Pap smear showing dysplasia or cancer; history of diethylstilbestrol exposure; persistent unexplained atypia of a Pap with evidence of human papillomavirus; suspicious visible lesion of the cervix, vagina, or vulva; and as a follow-up for previously treated clients. It is also highly recommended for clients with visible condylomata, unexplained vaginal discharge, or a sexual partner with condylomata.

Sandra says that her previous doctor never discussed why he took her off hormone replacement therapy (HRT). You share with her some of the results of the Women ' s Health Initiative (WHI). Which statement is true regarding the study? A. Estrogen plus progestin increased the risk of a cardiac event in apparently healthy women. B. Persons on HRT are at a higher risk of colorectal cancer. C. Postmenopausal hormones do not actually prevent fractures of the hip. D. Estrogen alone is associated with a greater risk of breast cancer than a combination of estrogen plus progestin.

Answer A - Estrogen plus progestin increased the risk of a cardiac event in apparently healthy women. The Women ' s Health Initiative (WHI) found that estrogen plus progestin increased the risk of a cardiac event in apparently healthy women. Users of postmenopausal hormones are actually at a lower risk of colorectal cancer; the mechanisms by which hormone use might reduce risk are unclear. The WHI was the first trial with definitive data supporting the ability of postmenopausal hormones to prevent fractures of the hip, vertebrae, and other sites. Estrogen plus progestin appears to be associated with greater risk of breast cancer than estrogen alone.

If a woman is using the basal body temperature (BBT) method of birth control and does not want to become pregnant, when would you tell her to avoid unprotected intercourse? A. From the beginning of the menstrual cycle until the BBT has been elevated for 3 days B. Whenever the BBT is elevated C. Whenever the BBT is lowered D. From the end of the menstrual cycle until the BBT has been low for 5 days

Answer A - From the beginning of the menstrual cycle until the BBT has been elevated for 3 days If a woman is using the basal body temperature (BBT) method of birth control and does not want to become pregnant, tell her to avoid unprotected intercourse from the beginning of the menstrual cycle or at least from day 4 (the day a period starts is considered day 1 until the BBT has been elevated for 3 days). When using the BBT method, the temperature is taken daily after a minimum of 3 hours of sleep, before rising, eating, or drinking, and is recorded. The preovulatory temperatures are suppressed by estrogen, whereas postovulatory temperatures are increased under the influence of heat-inducing progesterone. Temperatures typically rise within a day or two after ovulation has occurred and remain elevated for 2 weeks until menstruation begins.

Samantha has a diagnosis of a chlamydia vaginal infection. You believe that it is questionable whether she will fill the prescription that you write or take it for 7 days as ordered. What would you do? A. Give azithromycin (Zithromax) 1 g PO now. B. Emphasize the importance of the drug and tell her the consequences of not taking it. C. Send out the public health nurse to follow up on whether she takes the drug for 7 days. D. Assume that Samantha is an adult and will follow your instructions.

Answer A - Give azithromycin (Zithromax) 1 g PO now. An appropriate first-line drug for a Chlamydia vaginal infection is azithromycin (Zithromax) 1 g PO. Although doxycycline (Vibramycin) 100 mg PO twice daily for 7 days is the most tried-and-true and least expensive treatment, azithromycin is the most convenient option for single-dose administration. Azithromycin is contraindicated in pregnant women. For this population, erythromycin 500 mg PO four times a day for 7 days should be ordered.

A 27-year-old female presents to your office for a Mirena (levonorgestrel intrauterine system) insertion. She reports that her menses started 3 days ago and is normal. How soon after insertion will she be able to safely rely on it for contraception? A. Immediately B. After 48 hours C. In 1 week D. In 1 month

Answer A - Immediately The levonorgestrel intrauterine system (Mirena IUD) is a small T-shaped contraceptive device that was approved for use in the United States in 2000. This system releases levonorgestrel (progestin) directly into the endometrial cavity at an initial rate of 20 mcg per day and is utilized as a safe and effective contraceptive method that can provide continuous pregnancy prevention for up to 5 years and can be removed any time within that 5-year period. Although this IUD can be inserted at any time during the menstrual cycle, Mirena is effective immediately if inserted within 7 days after the start of menses. If Mirena is inserted at any other time during the menstrual cycle, another method of birth control during the first week after insertion should be used. Pregnancy protection will begin after 7 days.

Sydney, age 21, is taking an oral contraceptive (OC). She complains of acne. How should you adjust the estrogen in the OC? A. Increase the estrogen content. B. Decrease the estrogen content. C. Delete the estrogen content. D. No adjustment should be made to the estrogen content.

Answer A - Increase the estrogen content. If a client taking an oral contraceptive (OC) complains of acne, the estrogen in the OC should be increased or the progestin decreased. In addition, you should also discuss hygiene, diet, and topical antibiotic drug therapy.

Which of the following statements do you use when instructing women about their fertile period (when they are most likely to become pregnant)? A. Ovulation occurs on the 14 th day, plus or minus 2 days, before the next menses. B. Sperm are viable for 24 hours. C. The ovum is viable for 6 hours. D. The ovaries always release one ovum per month.

Answer A - Ovulation occurs on the 14 th day, plus or minus 2 days, before the next menses When instructing women about their fertile period (when they are most likely to become pregnant), tell them that ovulation occurs on the 14 th day, plus or minus 2 days, before the next menses. Sperm are viable for 3 days, and the ovum is viable for 24 hours. It is essential for women to know these facts if they are using the calendar or rhythm method for preventing a pregnancy. The ovaries may release more than one ovum per month or none at all, depending on the fertility status of the woman.

Which type of incontinence has an associated symptom of recurrent cystitis? A. Stress incontinence B. Urge incontinence C. Overflow incontinence D. Functional incontinence

Answer A - Stress incontinence Recurrent cystitis is an associated symptom of stress incontinence. Recurrent cystitis occurs more frequently in clients who have persistent residual urine resulting from an atonic bladder, cystocele, or diabetes mellitus. An associated symptom of urge incontinence (unstable detrusor contractions) is the inability to delay voiding long enough to reach the toilet. Neurogenic disorders are frequently associated with urge incontinence. Overflow incontinence is usually associated with benign prostatic hyperplasia and neurogenic conditions. Functional incontinence is incontinence caused by functional disabilities such as those associated with Alzheimer ' s disease or a cerebrovascular accident rather than any problem with structure.

Toxic shock syndrome (TSS) may be caused by which of the following? A. Tampon contamination with Staphylococcus aureus B. A short vaginal canal C. The use of superabsorbent tampons D. A urinary tract infection involving the bladder and kidneys

Answer A - Tampon contamination with Staphylococcus aureus Toxic shock syndrome (TSS) is a potentially lethal disorder that is caused in almost all cases by absorption of one or more toxins produced by colonized Staphylococcus aureus. Several mechanisms are implicated as causative, although not proven. They include tampon contamination with S. aureus, damaged cervical and vaginal mucosa, the use of superabsorbent tampons (or the synthetic materials they are made of) for an extended period of time, absorption of bacteriostatic cervical secretions, alterations in the normal vaginal flora, mechanical blockage of menstrual fluids, and the enhanced multiplication of the organism in the menstrual efflux. The incidence of TSS has decreased steadily as a result of education, altered patterns of tampon use, and the removal of extremely high-absorbency tampons from the market. A urinary tract infection involving the bladder and kidneys does not cause TSS.

Brianne, age 24, complains of urgency, frequency, and dysuria. Your dipstick test shows no hematuria, and her urine culture shows no growth. What is your next action? A. You suspect a sexually transmitted infection, so you obtain a culture of the urethra, do a potassium hydroxide wet prep, and obtain another urine culture. B. You suspect urethra irritation, so you tell her to take showers, not bubble baths, and wear white, dry underwear and loose-fitting clothing. C. You suspect a urinary tract infection not visible yet on culture, so you start her on Bactrim DS. D. You suspect that the vulva is irritated. You tell her to take a relaxing shower and dry the area well and come back in 1 week if there is no improvement.

Answer A - You suspect a sexually transmitted infection, so you obtain a culture of the urethra, do a potassium hydroxide wet prep, and obtain another urine culture. You suspect an sexually transmitted infection (STI) because although the symptoms are suspicious for a urinary tract infection (UTI), the diagnosis is not supported by the dipstick and urine culture results. Your next action for Brianne is to obtain a culture of the urethra, do a potassium hydroxide wet prep to test for bacterial vaginosis, and obtain another urine culture. Doing so is the most efficient way of treating Brianne now. Discussing her social history might help you determine which course of action is most appropriate. However, if you do only one test now and it is negative, you might have to perform another diagnostic test, thereby delaying treatment again. A diagnosis of Chlamydia infection is accomplished by culture or smears for Gram staining, but this is expensive and takes 2 - 6 days to obtain results. Other techniques include direct immunofluorescence assay and enzyme immunoassay. Diagnosis of gonorrhea is accomplished through cultures of the discharge (urethral, endocervical, rectal, pharyngeal, or conjunctive) using a modified Thayer-Martin medium or by Gram staining to look for typical gram-negative intracellular diplococci.

During a pelvic examination, you ask Mrs. Krane to Valsalva (strain). While doing this, a pouching is seen on the anterior wall of the vagina. This is indicative of A. a cystocele. B. a rectocele. C. an enterocele. D. a uterine prolapse.

Answer A - a cystocele. A cystocele is the prolapse into the vagina of the anterior vaginal wall and the bladder. Clinically, a pouching is seen on the anterior wall as the client strains. A rectocele is a prolapse into the vagina of the posterior vaginal wall and the rectum and is seen on the posterior wall as the client strains. An enterocele is a hernia of Douglas ' pouch into the vagina and would be seen as a bulge emerging from the posterior fornix. In first-degree uterine prolapse, the cervix appears at the introitus when the client strains.

Mrs. Peterson would like to be fitted for a diaphragm. She has been on numerous hormones in the past and does not like the side effects. It is important to remember that when properly fitting a patient for a diaphragm, it should A. allow a fingertip between it and the pubic arch. B. be small enough to allow for vaginal expansion. C. lie snugly over the pubic arch and under the cervix. D. provide firm tension against the vaginal walls

Answer A - allow a fingertip between it and the pubic arch The diaphragm is a barrier method of contraception that may provide up to 6 hours or more of birth control. It is a dome-shaped rubber cup that has a flexible rim and is inserted into the vagina before intercourse so the posterior rim rests in the posterior portion of the vagina and the anterior rim fits snugly behind the pubic bone. The diaphragm covers the cervix and is used in conjunction with spermicide. When fit correctly, there should be just enough space to insert one fingertip comfortably between the inside of the pubic arch and the anterior edge of the diaphragm rim.

Unilateral galactorrhea may be present with A. an intraductal papilloma. B. a woman who is lactating. C. a ruptured breast implant. D. pregnancy.

Answer A - an intraductal papilloma Galactorrhea (lactation not associated with pregnancy or nursing) is sometimes associated with a pituitary tumor. However, when the discharge is unilateral, from one or two ducts, a differential diagnosis of fibrocystic breast disease, intraductal papilloma, or carcinoma must be considered.

When premenstrual syndrome symptoms do not respond to dietary and nonmedical therapies, which of the following drugs might you try? A. Antidepressants B. Antihistamines C. Corticosteroids D. Anticholinergics

Answer A - antidepressants When premenstrual syndrome symptoms do not respond to other treatments, you may prescribe any of the following drugs to aid in alleviating the symptoms: antidepressants, such as paroxetine (Paxil), fluoxetine (Prozac), or sertraline (Zoloft) to raise the levels of serotonin; diuretics to help relieve bloating; gonadotropin-releasing hormone agonists to suppress the menstrual cycle; antianxiety agents such as alprazolam (Xanax); and an oral progesterone to help relieve bloating and moodiness.

In a premenopausal woman, the biggest heart attack risk factor is A. cigarette smoking. B. family history. C. sedentary lifestyle. D. obesity.

Answer A - cigarette smoking. In a premenopausal woman, the biggest heart attack risk factor is cigarette smoking. If a woman is premenopausal, her own estrogen is most likely to protect her from heart disease, but there are still risk factors associated with heart disease. The more risk factors that apply, the greater the danger. Smoking is the biggest risk factor. Others include a family history of premature heart disease (paternal side before age 55, maternal side before age 65), being older than age 54, going through premature menopause, sedentary lifestyle, and a history of diabetes or high blood pressure.

When a woman complains of dyspareunia in the lower back during orgasm, you should consider A. endometriosis. B. cystitis. C. vaginitis. D. causes related to pelvic inflammatory disease.

Answer A - endometriosis When a client complains of dyspareunia in the lower back during orgasm, you should consider a diagnosis of endometriosis. Cystitis and vaginitis should be considered when pain occurs at the vaginal canal and adjacent structures with the penis in midvagina. Pelvic inflammatory disease should be considered if pain occurs in the deep pelvis when there is deep penile penetration with thrusting. Causes of dyspareunia are many and diverse and depend on when and where the pain occurs.

Of the symptoms listed below, the most commonly expressed symptom of women with premenstrual syndrome is A. fatigue. B. depression. C. breast tenderness. D. swelling of the extremities.

Answer A - fatigue Of the symptoms listed in the question, the most commonly expressed symptom of women with premenstrual syndrome is fatigue (90%). Depression occurs about 80% of the time; breast tenderness, about 85%; and swelling of the extremities, about 67%. Other common symptoms include irritability (91%) and abdominal bloating (90%).

The best method to diagnose uterine polyps is a A. hysteroscopy. B. dilation and curettage. C. colposcopy. D. laparoscopy.

Answer A - hysteroscopy. The best method to diagnose uterine polyps is a hysteroscopy. A hysteroscopy is visualization of the endometrium through a scope to assess for some types of uterine fibroids, polyps, or structural abnormalities. Tissue sampling and removal of the polyps can be done through the hysteroscope. A dilation and curettage consists of scraping the walls of the uterus. A colposcopy is used to examine the vulva, vagina, and cervix. A laparoscopy examines the peritoneal cavity.

A sexually active woman should be aware that genital herpes simplex virus A. may be transmitted to a partner or newborn even in the absence of lesions because of viral shedding. B. is suppressed during menstruation, physical or emotional stress, immunosuppression, sexual intercourse, and pregnancy. C. recurrences usually last the same length of time as the initial outbreak. D. requires the use of condoms only during outbreaks.

Answer A - may be transmitted to a partner or newborn even in the absence of lesions because of viral shedding. A sexually active woman should be aware that genital herpes simplex virus may be transmitted to a partner or newborn even in the absence of lesions because of viral shedding. Genital herpes may be transmitted to a partner at any time; therefore, condoms should always be used. Menstruation, physical or emotional stress, immunosuppression, sexual intercourse, and pregnancy may actually trigger herpes recurrences. Herpes recurrences usually do not last as long as the initial occurrence.

Leiomyomas are found A. within the uterine wall. B. on the vaginal wall. C. within the cervix. D. on the fallopian tube.

Answer A - within the uterine wall. Leiomyomas are commonly called uterine fibroids; they are the most common benign tumor of the uterus. Most are small and asymptomatic. Leiomyomas are classified by location within the uterine wall and can be subserous, submucous, and/or intramural. Rarely, a leiomyoma can be intraligamentous, cervical, or parasitic (deriving its blood supply from an organ to which it becomes attached). Most uterine fibroids are surrounded by compressed (otherwise normal) myometrium. When leiomyomas outgrow their blood supply, they can become necrotic and ulcerate.

Jennifer, a 25-year-old female patient, complains of dysuria. In taking a thorough history to formulate a diagnosis, it is most important to ask, A. " Do you have painful intercourse? " B. " Do you have an associated vaginal discharge or irritation? " C. " Do you also have a problem with defecation? " D. " Do you have stress incontinence? "

Answer B - " Do you have an associated vaginal discharge or irritation? " Women with dysuria should be questioned about an associated vaginal discharge or irritation. Dysuria often represents a vaginal infection rather than a urinary tract infection. Women with dysuria from cystitis usually describe an internal discomfort, whereas women with dysuria from vaginitis usually describe a more external discomfort with the burning sensation in the vagina or labia, a result of urine flow over an inflamed vaginal mucosa.

Mary, age 50, desires hormone replacement therapy (HRT) for her hot flashes, which she can ' t stand. You ' ve discussed the pros and cons and given her some alternative suggestions. Her mother had a history of osteoporosis. You have decided to initiate therapy for 1 year. She asks you if she also needs to take calcium or vitamin D for prevention of osteoporosis. How do you respond? A. " Research has shown that HRT alone is sufficient to protect against osteoporosis. " B. " Yes, calcium intake should be increased to 1,200 mg/day along with 600 mg of vitamin D to decrease bone turnover and increase intestinal absorption. " C. " If you decide to take calcium and vitamin D, you can stop the HRT. " D. " If you are getting sufficient exercise, you don ' t need to take calcium and vitamin D. "

Answer B - " Yes, calcium intake should be increased to 1,200 mg/day along with 600 mg of vitamin D to decrease bone turnover and increase intestinal absorption. " Hormone replacement therapy (HRT) may be used for short-term effectiveness in treating hot flashes in the absence of a personal or family history of breast cancer or a previous problem with venous thrombosis. It is no longer considered cardioprotective. It is effective in preventing bone loss. Prevention of osteoporosis includes HRT, exercise to help decrease bone turnover, and 1,200 mg of calcium and 600 mg of vitamin D per day. For women not on HRT, calcium should be increased to 1,500 mg/day.

The Mobiluncus species is responsible for which sexually transmitted infection? A. Condylomata acuminata B. Bacterial vaginosis C. Human papillomavirus D. Lymphogranuloma venereum

Answer B - Bacterial vaginosis The Mobiluncus species causes bacterial vaginosis. The human papillomavirus is responsible for condylomata acuminata (genital warts). Lymphogranuloma venereum is a sexually transmitted infection characterized by localized lymphatic infection with a Chlamydia origin

You ' ve just finished a Pap smear on Sadie, age 39. During the wet mount, you see cells with bacteria adherent to the cell wall giving it a stippled, granular appearance. What do you suspect? A. Candidiasis B. Bacterial vaginosis C. Trichomoniasis D. Cervicitis

Answer B - Bacterial vaginosis With the wet mount for bacterial vaginosis (BV), you will see clue cells — characteristic epithelial cells with bacteria adherent to the cell wall giving a stippled, granular appearance. BV is the most prevalent form of vaginitis among childbearing women. With candidiasis, the microscopic examination of the vaginal solution diluted with saline or 10% KOH (potassium hydroxide) preparations will demonstrate hyphal forms or budding yeast cells in 50% - 70% of infected women. With trichomoniasis, you will visualize motile flagellated trichomonads.

Which type of cyst of the female reproductive system usually results in pain, redness, a perineal mass, and dyspareunia? A. Ovarian cyst B. Bartholin ' s cyst C. Gardner ' s cyst D. Nabothian cyst

Answer B - Bartholin ' s cyst Bartholin ' s cyst is an obstruction or infection of the Bartholin ' s gland. It results in pain, redness, a perineal mass, and dyspareunia. An ovarian cyst may be functional or inflammatory. A functional ovarian cyst occurs during ovulation and may be asymptomatic and resolve spontaneously, or it can cause pain, menstrual irregularity, or amenorrhea. An inflammatory cyst is an infection of the ovary or uterine tube and results in an elevated white blood cell count, a low-grade fever, pain, and excessive menstrual flow. A Gardner ' s duct cyst is present in the vagina during fetal development and usually goes away before birth. However, it can be persistent after birth on the sidewalls of the vagina and does not cause any symptoms. A nabothian cyst is a mucus-filled lump on the surface of the cervix and is asymptomatic.

Judy has severe pain monthly with her fibrocystic breast disease. Which medication do you suggest she try? A. Micronized estradiol (Estrace) B. Danazol (Danocrine) C. Paroxetine (Paxil) D. Venlafaxine (Effexor)

Answer B - Danazol (Danocrine) For clients with severe pain with their fibrocystic breast disease, danazol (Danocrine) 100 - 200 mg twice per day has been found helpful. Danazol is an androgen derivative that suppresses pituitary gonadotropins. With its androgenic effects, such as acne, edema, and hirsutism, most women find that the treatment is worse than the condition and prefer to try milder forms of pain relief. A daily dose of 400 IU of vitamin E may also help. Paroxetine (Paxil) and venlafaxine (Effexor) are both selective serotonin reuptake inhibitors (SSRIs) that have been shown in some studies to relieve hot flashes as well as hormone therapy can.

Sarah, age 29, complains of premenstrual syndrome. She states she was told that changing her diet might help in managing some of the symptoms. What changes in her diet do you recommend? A. Increase her intake of protein. B. Increase her intake of complex carbohydrates. C. Increase her intake of salt and salty foods. D. Decrease her intake of fatty foods.

Answer B - Increase her intake of complex carbohydrates. In the client complaining of premenstrual syndrome, advise her to increase her intake of complex carbohydrates. A diet high in complex carbohydrates, such as whole grains and cereals, fruits, and vegetables, helps prevent low blood sugar levels and reduces fatigue, jitteriness, and irritability. It may also raise serotonin levels, thus improving mood. Eating several small meals at frequent intervals rather than three large ones also keeps blood sugar on an even level and reduces the feeling of bloating. Women should also restrict their intake of salt, caffeine, and alcohol during the week before their period.

A dancer from an adult club down the street comes in for a renewal of her birth control pill prescription. She says that everything is fine. On examination, you find grayish-white vaginal discharge, greenish cervical discharge, and cervical motion tenderness. Which of the following differential diagnosis is most unlikely? A. Gonorrhea B. Interstitial cystitis C. Bacterial vaginosis D. Chlamydia

Answer B - Interstitial cystitis Interstitial cystitis is a chronic disease with none of the symptoms given in the stem of the question. A client who presents with grayish-white vaginal discharge, greenish cervical discharge, and cervical motion tenderness may have gonorrhea, bacterial vaginosis, or Chlamydia infection. Gonorrhea may be asymptomatic or the client may present with yellowish urethral or vaginal discharge. The discharge of bacterial vaginosis is typically gray-white, malodorous or fishy smelling, and pruritic. Chlamydia infection may present with or without a vaginal or urethral discharge.

According to the United States Medical Eligibility Criteria (US MEC) for Contraception Use, indicate the appropriate US MEC category for a 28-year-old woman with type 1 diabetes mellitus without vascular disease for combined hormonal contraceptives (i.e., combined oral contraceptive, patch, or vaginal ring). A. Category 1 B. Category 2 C. Category 3 D. Category 4

B. Category 2

Which of the following drugs may have their effects diminished when used in combination with an oral contraceptive? A. Corticosteroids B. Oral anticoagulants C. Antibiotics D. Anticonvulsants

Answer B - Oral anticoagulants The effects of oral anticoagulants, acetaminophen, some benzodiazepines, oral hypoglycemic agents, and methyldopa may be diminished when used in combination with oral contraceptives.

Which type of breast cancer involves infiltration of the nipple epithelium and has an initial symptom of itching or burning of the nipple? A. Ductal cancer B. Paget ' s disease C. Mammary duct ectasia D. Fibroadenoma

Answer B - Paget ' s disease Paget ' s disease (Paget ' s carcinoma) is a rare type of breast cancer involving infiltration of the nipple epithelium. It begins with itching or burning of the nipple combined with superficial erosion, crusting, or ulceration. It is usually misdiagnosed as an infection. It has an excellent prognosis if the cancerous changes are confined to the nipple. Mammary duct ectasia, also known as plasma cell mastitis, is a palpable lumpiness found beneath the areola. Duct ectasia involves periductal inflammation, dilation of the ductal system, and an accumulation of fluid and dead cells that block the involved ducts. It is sometimes difficult to differentiate from cancer because it also occurs in perimenopausal or late premenopausal women. Fibroadenomas are overgrowths of periductal stromal connective tissue that compress ducts into well-defined lumps with circumscribed edges and smooth boundaries. They are mobile, firm, and nontender lumps and usually occur in women younger than age 25.

Jennifer, age 27, is complaining of lower abdominal pain. After doing some laboratory studies, you find leukocytosis, an elevated erythrocyte sedimentation rate, and an elevated C-reactive protein level. Which is the most appropriate diagnosis? A. Ovarian cyst B. Pelvic inflammatory disease C. Tubal pregnancy D. Diverticulitis

Answer B - Pelvic inflammatory disease In clients with pelvic inflammatory disease, leukocytosis is present in about 50% of the cases, the erythrocyte sedimentation rate is classically elevated, and the C-reactive protein level is usually elevated (exceeding 20 mg/L) in about 74% of the cases.

Which of the following is a sexually transmitted infection? A. Candida vaginitis B. Trichomonal vaginitis C. Atrophic vaginitis D. Lactobacilli vaginitis

Answer B - Trichomonal vaginitis Trichomonal vaginitis is a sexually transmitted infection. Monilial vaginitis, atrophic vaginitis, and bacterial vaginosis (BV) are all nonsexually transmitted types of vaginitis. Vulvovaginal candidiasis (formerly Monilia species), although not an STI, may be transmitted between partners and between mother and newborn. Atrophic vaginitis is present in postmenopausal women who are not on hormone replacement therapy. BV is the most common vaginitis in women of reproductive age, of which almost 50% are asymptomatic. It results in changes in the vaginal bacterial flora with a loss of lactobacilli, an increase in vaginal pH (pH 4.5), and an increase in multiple anaerobic and aerobic bacteria. BV may be caused by multiple bacteria and some cases may be transmitted sexually.

A 17-year-old female patient requests to start Depo-Provera injections as her method of birth control. She discloses that she has had four sexual partners in the past year. Her last menstrual period was 12 days ago and she had unprotected intercourse 3 days ago. The appropriate management for this patient would be to A. administer the injection today. B. advise her to use another method for now and return with her next menses. C. give the injection after a negative pregnancy test and tell her to use condoms for the next 7 days. D. give the injection and tell her to use a barrier method for 7 days.

Answer B - advise her to use another method for now and return with her next menses. Depo-Provera is the most commonly used injectable contraceptive that contains depot medroxyprogesterone acetate (DMPA). Given by intramuscular injection, DMPA 150 mgs is given every 12 weeks and provides highly effective contraception when used properly. The DMPA injection can be given anytime during the menstrual cycle as long as the woman can be reasonably certain that she is not pregnant (World Health Organization). If DMPA is given within 5 - 7 days of a normal last menstrual period, no backup is needed. If it is given after the 7 th day in the menstrual cycle, back up contraception is needed. In this scenario, this patient had unprotected intercourse 3 days ago, so a pregnancy test would not provide accurate results at this time.

Dysfunctional uterine bleeding is usually associated with A. pregnancy. B. anovulation. C. genital tumor. D. inflammation.

Answer B - anovulation. Dysfunctional uterine bleeding (DUB) is excessive, prolonged, and unpatterned bleeding from the endometrium in the absence of any structural pelvic pathology. It is usually associated with anovulation. DUB is not related to pregnancy, inflammation, genital tumor, or other anatomical uterine lesion. Although no organic problems are associated with DUB, a history and physical examination and pelvic and rectal examinations are done to rule out neoplasia. These are followed by diagnostic tests and blood work.

Emotional support is best given to the client with a sexually transmitted infection by A. offering many alternatives. B. authentic active listening. C. assuring the client that everything will be okay. D. emphasizing the duration of the disease.

Answer B - authentic active listening Emotional support is best given to the client with a sexually transmitted infection (STI) by authentic active listening. During times of increased psychological stress, minimizing choices is better than offering too many choices. The client with an STI needs support from others, and emphasis should focus on the prevention of recurrences rather than the specifics of the duration of the disease.

Mrs. Henderson inquires about why she needs progesterone in addition to her estrogen for hormone replacement. Women who have an intact uterus need to add progesterone to their prescribed estrogen because progestin A. assists in relieving the typical hot flashes of menopause. B. reduces the incidence of endometrial hyperplasia and cancer. C. decreases the risk of osteoporosis. D. controls mood swings.

Answer B - reduces the incidence of endometrial hyperplasia and cancer A woman with an intact uterus needs to add progestin to her estrogen replacement therapy — estrogen plus progestin therapy (EPT) — because it reduces the incidence of endometrial hyperplasia and cancer, both of which are associated with long-term estrogen use. Decreased estrogen levels account for hot flashes. Discussion about discontinuing hormone replacement therapy should begin.

A 21-year-old woman comes to your office and reports a history of genital warts. In reference to the HPV vaccination (Gardasil or Cervarix), she should be educated that A. she is not in the correct age group and is not a candidate for the vaccination. B. she should receive the HPV vaccination. C. she already has been exposed to HPV; therefore, she is not a candidate for the vaccine. D. there is a vaccine coming out shortly specifically for those who have been exposed. She should wait.

Answer B - she should receive the HPV vaccination. The human papillomavirus is the most common sexually transmitted infection (STI). There are more than 40 HPV types that can infect the genital areas, mouth, and throat of males and females. According to the Centers for Disease Control and Prevention (CDC), females should get the vaccine before they become sexually active and prior to becoming exposed to HPV. Females who are sexually active may also benefit from the vaccine, but they may get less benefit from it. Women who have an existing history of genital warts have generally been exposed to HPV types 6 and 11, which are not oncogenic. However, few sexually active young women are infected with all HPV types prevented by the vaccines, so most young women could still get protection by getting vaccinated

Ursula, age 19, is going to begin taking birth control pills. She asks you if she is " safe " immediately. How do you respond? A. " Yes, you should not get pregnant once you start taking the pill. However, it doesn ' t protect you from STIs. " B. " For the first month, you need to be on a backup birth-control method. However, the pill doesn ' t protect you from STIs. " C. " A second birth control method needs to be used during intercourse for the first 7 days while taking the pill. However, the pill doesn ' t protect you from STIs. " D. " Until you have your second period (cycle) with the pill, you are not considered safe. "

Answer C - " A second birth control method needs to be used during intercourse for the first 7 days while taking the pill. However, the pill doesn ' t protect you from STIs. " When a client is first starting to take birth control pills, she should be instructed to use a second birth control method during intercourse, such as condoms or a diaphragm used with spermicide, for the first 7 days. Another contraceptive method should always be kept on hand to use in case of missed pills; when taking another medication that might interfere with pill effectiveness, such as an antibiotic; or when vomiting or diarrhea occurs

Beth is breastfeeding her 3-month-old infant with no supplementation. She says she has heard that she cannot get pregnant during this time. What do you tell her? A. " It ' s highly likely that you may become pregnant, so you should use another method of birth control. " B. " Yes, you ' re safe for as long as you breastfeed. " C. " For the first 6 months, if you breastfeed and have very little supplementation, your chances are less than 2% that you ' ll get pregnant. " D. " You ' re more at risk for getting pregnant now because of your fluctuating hormone levels. "

Answer C - " For the first 6 months, if you breastfeed and have very little supplementation, your chances are less than 2% that you ' ll get pregnant. " Women have less than a 2% chance of getting pregnant as long as they are amenorrheic for 2 months postpartum; are fully breastfeeding, with a supplementation not exceeding 15%; and are less than 6 months postpartum. If any of these conditions is not present, the woman needs to begin to use another form of contraception.

According to the United States Medical Eligibility Criteria (US MEC) for Contraception Use, indicate the appropriate US MEC category for a 32-year-old woman breastfeeding a 6-month-old infant for combined hormonal contraceptives (i.e., combined oral contraceptive, patch, or vaginal ring). A. Category 1 B. Category 2 C. Category 3 D. Category 4

B. Category 2

Lynne, age 43, comes to your office in tears, stating that last night she had unprotected sex and forgot to take her birth control pill. She wants to know about the " morning-after pill. " You tell her, A. " If your period does not start at the scheduled time, come back to see me. " B. " I ' ll go ahead and order the estrogen-only postcoital contraception pill. " C. " I ' ll go ahead and order the Yuzpe regimen. " D. " I ' ll refer you to a gynecologist. "

Answer C - " I ' ll go ahead and order the Yuzpe regimen. " Emergency contraception, referred to as postcoital contraception, prevents pregnancy after unprotected sexual intercourse. It should ideally be taken within 72 hours after unprotected intercourse. Waiting for menses to start or referring the client to a gynecologist is too late. In the United States, three methods are available. The Yuzpe regimen consists of taking two birth control pills within 72 hours and two more 12 hours later. This is 75% effective. A medication for nausea should be taken before the birth control pills. An alternative plan is to take progestin-only postcoital contraceptives, which reduce the risk of pregnancy by 89%. One pill (levonorgestrel 75 mg) is taken within 72 hours of unprotected sex and another 12 hours later.

Which of the following drugs may diminish the effectiveness of oral contraceptives? A. Beta blockers B. Oral anticoagulants C. Antibiotics D. Oral hypoglycemics

Answer C - Antibiotics Antibiotics, antacids, anticonvulsants, and barbiturates may diminish the effectiveness of oral contraceptives. Clients should be urged to use other methods of birth control when taking antibiotics.

A 26-year-old female comes to your office to discuss birth control options. Her history includes migraine headaches with aura while on combination oral contraceptives in the past. She does not want to become pregnant. Which of the following birth control options would be the best choice for her? A. Combined hormonal contraceptive pills B. Ortho Evra Patch C. Mirena IUD D. Vaginal NuvaRing

Answer C - Mirena IUD Women who have a history of migraine headaches with aura on combination oral contraceptives should not take estrogen containing contraception. Combined oral contraceptive pills, the Ortho Evra patch, and the vaginal NuvaRing all contain an estrogen hormone. The Mirena IUD contains levonorgestrel, which is a progestin.

Small-quantity incontinence with nearly continuous dribbling is symptomatic of which kind of incontinence? A. Stress incontinence B. Urge incontinence C. Overflow incontinence D. Functional incontinence

Answer C - Overflow incontinence Small-quantity incontinence, which produces nearly continuous dribbling, is symptomatic of overflow incontinence. Stress incontinence is symptomized by small-quantity incontinence on coughing, sneezing, laughing, and running. Urge incontinence involves an uncontrolled urge to void and is symptomized by large-quantity incontinence. Functional incontinence involves voiding normally with assistance.

Which of the following signs and/or symptoms of a genital herpes infection usually occurs first? A. Painful or pruritic vesicles B. Dysuria C. Prodromal tingling or pruritus of the genital region D. White, curdlike plaques on a red base in the vagina

Answer C - Prodromal tingling or pruritus of the genital region Signs and symptoms of a genital herpes infection include tender inguinal lymph nodes, as well as painful or pruritic vesicles, dysuria, prodromal tingling or pruritus of the genital region (which usually occurs first), and cervical ulcerations. White, curdlike plaques on a red base in the vagina are seen with monilial vaginitis.

First-line treatment for polycystic ovary syndrome is A. a bilateral oophorectomy. B. oral testosterone therapy. C. a combination of diet modification, weight loss, and stress management. D. a laparoscopy with a bilateral wedge resection.

Answer C - a combination of diet modification, weight loss, and stress management. First-line treatment for polycystic ovary syndrome (PCOS) is a combination of diet modification, weight loss, and stress management because obesity and stress alone can contribute to androgen excess. Oral estrogens are considered the first-line treatment for hyperandrogenism, with combination (estrogen and progesterone) oral contraceptives being the medication of choice. Treatment of uncomplicated amenorrhea in PCOS requires, at a minimum, monthly or bimonthly administration of medroxyprogesterone acetate (Depo-Provera). A laparotomy with a bilateral wedge resection is a treatment for anovulation. Because of the possibility of adhesions and ovarian atrophy, surgical interventions are used only in women who have tried and failed clomiphene citrate ovulation induction and when all other noninvasive options have been considered.

Human papillomavirus may lead to A. pelvic inflammatory disease. B. molluscum contagiosum. C. cervical dysplasia. D. genital herpes.

Answer C - cervical dysplasia. When human papillomavirus (Condylomata acuminata) causes genital warts, it may lead to cervical dysplasia and cervical cancer. Pelvic inflammatory disease is usually secondary to gonorrhea or Chlamydia infection. Molluscum contagiosum is a sexually transmitted disease that causes a benign viral skin infection. Genital herpes is caused by herpes simplex virus.

An occurrence of genital herpes is A. cured with acyclovir (Zovirax). B. best managed with trichloroacetic acid 80% - 90% applied directly to the lesion. C. expected to be completely resolved within 21 days (for the primary lesion). D. not a factor in continuing with intercourse.

Answer C - expected to be completely resolved within 21 days (for the primary lesion). Although the primary lesion of genital herpes normally resolves within 21 days, the client usually has recurrent episodes. Acyclovir (Zovirax) is a palliative management option, but the drug does not cure herpes simplex. Topical trichloroacetic acid is the treatment for genital warts, not herpes. Intercourse should be avoided when a lesion is present.

Women who take oral contraceptives are less likely to experience A. human papillomavirus infection. B. migraine headache. C. iron-deficiency anemia. D. herpes simplex virus.

Answer C - iron-deficiency anemia. Iron-deficiency anemia is usually helped when women take an oral contraceptive (OC) because women on an OC tend to lose less blood each month. Other noncontraceptive benefits or conditions for which OC use offers protection include ovarian and endometrial carcinoma, ectopic pregnancy, pelvic inflammatory disease, functional ovarian cysts, menstrual irregularities, dysmenorrhea, benign breast disease, and premenstrual syndrome.

Marsha, age 40, has been given a diagnosis of rheumatoid arthritis. She asks you whether she should continue taking her birth control pills. You tell her A. to check with her rheumatologist. B. to stop. C. to continue. D. the dose will have to be altered

Answer C - to continue If your client with rheumatoid arthritis (RA) is taking birth control pills, she should continue taking them, as well as any medications for her RA.

Candidiasis is more common in A. teenage girls. B. women on low-fat diets. C. women with diabetes. D. women with frequent urinary tract infections.

Answer C - women with diabetes. Candida albicans infection is more common in women with diabetes, as well as those who are pregnant, immunosuppressed, or using antibiotics or oral contraceptives

17-year-old female presents to your office with the complaint of lower abdominal pain since her period ended 2 days ago. She has a new sexual partner in the past 3 months and does not use condoms. On physical examination, you find that she has cervical motion tenderness. You are concerned that she may have pelvic inflammatory disease (PID). To meet the Centers for Disease Control and Preventions's minimum criteria for empiric treatment of PID, she must also have A. an oral temperature greater than 101 ° F and mucopurulent cervicitis. B. a positive test for cervical infection and an adnexal mass. C. lower abdominal tenderness and adnexal tenderness. D. mucopurulent cervicitis and an elevated white blood cell count

Answer C lower abdominal tenderness and adnexal tenderness. Pelvic inflammatory disease (PID) comprises a spectrum of inflammatory disorders of the upper female genital tract. Sexually transmitted organisms, especially Neisseria gonorrhoeae and Chlamydia trachomatis, are implicated in many cases. Empiric treatment for PID should be initiated in sexually active young women and other women at risk for sexually transmitted infections if they are experiencing pelvic or lower abdominal pain, if no cause for the illness other than PID can be identified, and if one or more of the following minimum criteria are present on pelvic examination: cervical motion tenderness, uterine tenderness, adnexal tenderness.

Mrs. Williams would like to schedule an appointment to bring her 18-year-old daughter in to see you for her first gynecological exam and Pap smear. The most appropriate reply would include A. " I would be happy to see your daughter and complete her gynecological exam and Pap smear. " B. " Your daughter does not need a gynecological exam and Pap at this time. " C. " Your daughter only needs a gynecological exam and Pap smear when she becomes sexually active. " D. " I would be happy to see your daughter and complete her gynecological exam; however, she does not need a Pap smear until the age of 21. "

Answer D - " I would be happy to see your daughter and complete her gynecological exam; however, she does not need a Pap smear until the age of 21. " In the past, the American Cancer Society, the American College of Obstetricians and Gynecologists (ACOG), and the American Society of Colposcopy and Cervical Pathology (ASCCP) recommended the initiation of cervical cytology screening in an adolescent based on time since onset of vaginal intercourse. However, there was much confusion and nonadherence to the guidelines. Many adolescents were being screened inappropriately. A study by Barnholtz-Sloan and colleagues shows that screening in adolescents does not appear to change the rate of cervical cancer in these groups, and the ACOG and ASCCP now recommend that cervical cytology screening begin at age 21 years, regardless of the age of onset of sexual activity. The few rare cases of cervical cancer in this population do not appear to have been preventable by screening.

Julia, age 60, asks you about taking alendronate (Fosamax). What do you tell her about using this medication? A. " If you decide to take it, stick with a lower dose of 5 mg because the side effects are much worse with a 10 mg dose. " B. " Fosamax works better in younger women, so you should start this now rather than wait until you ' re 70. " C. " You should take a daily dose because the weekly dose is not as effective. " D. " In addition to its efficacy in the treatment of osteoporosis in postmenopausal women, it is also useful for the prevention of osteoporosis. "

Answer D - " In addition to its efficacy in the treatment of osteoporosis in postmenopausal women, it is also useful for the prevention of osteoporosis. " In addition to its efficacy in the treatment of osteoporosis in postmenopausal women, alendronate (Fosamax) is useful for the prevention of osteoporosis. Weekly administration of Fosamax is as effective as daily dosing. The risk of side effects is similar for doses of 5 mg, 10 mg, or greater. Fosamax appears to be equally effective in older and younger postmenopausal women with osteoporosis.

How long can the vaginal contraceptive ring (Nuvaring) be out of the vagina before an additional form of contraception is necessary? A. 30 minutes B. 1 hour C. 2 hours D. 3 hours

Answer D - 3 hours A vaginal contraceptive ring (NuvaRing) is a soft, transparent, flexible ring of ethylene vinyl acetate copolymer. The ring releases 120 mcg of etonogestrel and 15 mcg of ethinyl estradiol daily. The ring is placed in the vagina once every 28 days and kept in place for 21 days. The ring is then removed for a 7-day period to allow for a withdrawal bleed. If the ring is accidentally expelled from the vagina for less than 3 hours, instruct the woman to rinse it with lukewarm water and reinsert it into her vagina. No backup method is needed. If the ring is expelled from the vagina for 3 hours or more, instruct the woman to discard the ring and (a) insert a new ring immediately and use backup method for an additional 7 days, or (b) have a withdrawal bleed and insert a ring no later than 7 days from when the last ring was removed and use backup methods for 7 days

Sharon states that she has heard that douching effectively washes out the sperm after intercourse and that she has been using this as a method of birth control. Which of the following statements about douching is true? A. Douching prevents sperm from entering the uterus. B. Douching should be used at least once a month after menses if not used after intercourse. C. Douching is a reliable contraceptive. D. Douching may increase the risk of ectopic pregnancy.

Answer D - Douching may increase the risk of ectopic pregnancy. Douching will not prevent sperm from entering the uterus because sperm may enter the cervical canal as soon as 15 seconds after ejaculation. Douching may even enhance the movement of sperm up the canal because it washes fluids deeper into the vagina and washes away the protective mucus. Douching has been associated with an increased risk of pelvic infection and ectopic pregnancy and most gynecologists do not recommend it at any time.

Which of the following conditions is a contraindication to using the copper intrauterine device (IUD)? A. History of ectopic pregnancy B. Nulliparity C. Treated cervical dysplasia D. Heart disease

Answer D - Heart disease Heart disease is considered a contraindication to the use of a copper intrauterine device (IUD) because the client may be susceptible to bacterial endocarditis. The following conditions were previously believed to preclude the use of IUDs, including the copper IUD, but they are no longer contraindications: history of ectopic pregnancy (remains a contraindication to use with the progesterone-containing IUDs), nulliparity, treated cervical dysplasia, diabetes mellitus, valvular heart disease, irregular menses as a result of anovulation, breastfeeding, corticosteroid use, and age under 25 years. The conditions that preclude systemic hormonal methods (breast cancer, venous thromboembolism or phlebitis, arterial vascular disease, active liver disease, and age older than 35 combined with smoking) do not preclude intrauterine contraception.

Joanne wants to use some form of birth control, but because she is getting married next year, she wants to be able to stop the birth control method after the wedding and have her fertility restored almost immediately. Which method do you recommend for her? A. Birth control pills B. Vaginal ring C. Depot-medroxyprogesterone acetate (DMPA) injections D. Lea's Shield

Answer D - Lea's Shield Lea ' s Shield is the only product listed that does not contain hormones that may delay pregnancy after discontinuing use. Lea ' s Shield is similar to the diaphragm and cervical cap but is more user friendly. The dome-shaped silicone device covers the cervix, allowing for secretions to exit without sperm entering in. The shield is used with spermicide. There may be a temporary delay in conception after discontinuing oral contraceptives, although the exact time is unclear. Return to fertility with depot-medroxyprogesterone acetate (DMPA) may be delayed regardless of the duration of its use. DMPA injections are given every 3 months. A vaginal ring (NuvaRing) releases synthetic hormones and is worn for 21 days and then removed for 7 days to allow for a menstrual period. The vaginal ring has similar side effects to that of oral contraception.

Dana is a 23-year-old patient diagnosed with dyspareunia. Which of the following is NOT a cause for this condition? A. Vulvovaginitis B. An incompletely stretched hymen C. Vaginismus D. Multiple pregnancies

Answer D - Multiple pregnancies Multiple pregnancies are not associated with dyspareunia. Dyspareunia (painful intercourse) may be caused by vulvovaginitis, an incompletely (or inadequately) stretched hymen during the initial intercourse, vaginismus, endometriosis, tumors or other pathological conditions, or psychosexual conflicts.

The most common type of vaginal infection is A. candidiasis. B. trichomoniasis. C. gonorrhea. D. bacterial vaginosis

Answer D - bacterial vaginosis Bacterial vaginosis (BV) is the most common vaginal infection (about 40% of all cases). The infecting organisms are identified as Gardnerella vaginalis, Mobiluncus species, and other anaerobes. Bacterial vaginosis results in an overgrowth condition within the vagina for as-yet-unknown reasons. The incubation period is 5 - 10 days. About half of all clients with BV are asymptomatic. Those with symptoms typically describe a gray-white, malodorous or fishy-smelling, pruritic discharge that is accompanied by burning. It may be scant to profuse and adheres to the vaginal walls. The differential diagnoses include any other known cause for vaginitis (such as trichomoniasis or candidiasis) and cervicitis (such as gonorrhea or Chlamydia infection). Diagnosis is made through microscopic examination of the specimen by wet mount. The practitioner should look for clue cells; the presence of these cells, which look like pepper on the surface of cells, is diagnostic of BV.

In a patient diagnosed with cervical gonococcal infection, you would also suspect a co-infection with A. candidiasis. B. syphilis. C. trichomoniasis. D. chlamydia.

Answer D - chlamydia. Simultaneous chlamydial infections are present in 30% - 50% of clients who have cervical gonococcal infections. Treatment should automatically be done for both when one has been diagnosed. The most common therapies are azithromycin (Zithromax) 1 g PO for one dose for Chlamydia infection and ceftriaxone (Rocephin) 125 mg IM for one dose for gonorrhea.

Reiter ' s syndrome is a complication of A. bacterial vaginosis. B. syphilis. C. chlamydia. D. gonorrhea.

Answer D - gonorrhea Gonorrhea may precipitate Reiter ' s syndrome (reactive arthritis). Bacterial vaginosis seldom results in complications. Syphilis may result in disseminated disease, but not Reiter ' s syndrome. Left untreated in women, Chlamydia infections may cause scarring in the uterine tubes, leading to infertility and ectopic (tubal) pregnancies.

Infertility is best defined as the A. inability to conceive with multiple sex partners. B. inability to conceive for 9 months of unprotected intercourse when both partners are younger than 30 years of age. C. state of voluntary childlessness. D. inability to conceive after 1 full year of unprotected intercourse.

Answer D - inability to conceive after 1 full year of unprotected intercourse. Infertility is a disease that affects approximately 15% of reproductive age couples (ages 15 - 44) in the United States. Although pregnancies do occur outside this age range, they are less frequent. Infertility is defined as the failure of a couple to conceive after 12 months of frequent, unprotected intercourse.

Menses at irregular intervals with excessive flow and duration is defined as A. oligomenorrhea. B. polymenorrhea. C. menorrhagia. D. metrorrhagia.

Answer D - metrorrhagia. Metrorrhagia is menses with irregular intervals and excessive flow and duration. Oligomenorrhea is menses with an interval of more than 35 days. Polymenorrhea is menses with intervals of less than 21 days. Menorrhagia is menses of regular normal intervals, but with extensive flow and duration

Endometrial cancer, hirsutism, acne, breast cancer, increased risk of diabetes, infertility, menstrual bleeding problems, and an increased risk of cardiovascular disease are clinical consequences of A. mastalgia. B. menorrhagia. C. endometriosis. D. persistent anovulation

Answer D - persistent anovulation. The clinical consequences of persistent anovulation include infertility; menstrual bleeding problems, ranging from amenorrhea to dysfunctional uterine bleeding; an increased risk of cardiovascular disease; hirsutism and acne; an increased risk of endometrial cancer and breast cancer; and an increased risk of diabetes mellitus in clients with hyperinsulinemia. Therapy depends on the client. If the client wants to get pregnant, she is a candidate for the medical induction of ovulation. For the client who does not wish to become pregnant and does not complain of hirsutism but is anovulatory and has irregular bleeding, therapy is directed toward interruption of the steady-state effect on the endometrium and breast. Mastalgia is breast pain. The breast is a complex organ that is sensitive to hormones. Estradiol and progesterone stimulate breast tissue. Breast pain that positively correlates with menses is cyclic mastalgia. Cyclic mastalgia is the most common breast-related complaint seen in women ' s health practice. Menorrhagia is excessive bleeding but at the normal time during the month. Endometriosis is extrauterine growth of the endometrial glands or stroma. It is believed to occur through retrograde menstruation, or differentiation of totipotential cells, or both.

The most likely cause of amenorrhea is A. an anatomical deviation. B. a genetic factor. C. an endocrine abnormality. D. pregnancy.

Answer D - pregnancy Although pregnancy seems like an obvious choice as the most likely cause of amenorrhea, it is sometimes overlooked, especially if the client denies the possibility of pregnancy and is seeking a pathological reason for the amenorrhea. The most likely physiological causes of amenorrhea that should be considered are pregnancy, lactation, and menopause, if appropriate. Among women who are in the childbearing years, amenorrhea unrelated to pregnancy may signal stress or a lifethreatening disease. These conditions may include anatomical deviations, genetic factors, endocrine abnormalities or imbalances, defective enzyme systems, autoimmune diseases, tumors, eating disorders, excessive exercise, and medications. With amenorrhea, a pregnancy test should always be done first to rule out pregnancy or its related complications: ectopic pregnancies, complete or incomplete abortions, and trophoblastic neoplasms. The most accurate test for pregnancy is the serum beta human chorionic gonadotropin test.

Characteristics of polycystic ovary syndrome include A. hirsutism, thinness, hypoinsulinemia. B. menopausal onset, vitiligo, hyperinsulemia. C. alopecia, thinness, abdominal cramping. D. premenarchial onset, obesity, hyperinsulinemia.

Answer D - premenarchial onset, obesity, hyperinsulinemia. Characteristics of polycystic ovary syndrome (PCOS) include premenarchal onset, obesity, hyperinsulinemia, hyperandrogenism (hirsutism, seborrhea, acne, alopecia), menstrual disturbances, and infertility. Visible signs of the syndrome are obesity, acne, and hirsutism. Clients with PCOStypically present with complaints of amenorrhea or irregular menstrual cycles, but some have the initial complaint of infertility. About 10% - 20% of clients with PCOS are symptomatic. PCOS should be considered in all clients presenting with amenorrhea, infertility, or hirsutism.

Gerri, a 33-year-old female patient, complains of external vaginal irritation after adding new fabric softener to her laundry. You have diagnosed her with reactive vaginitis. The treatment of choice for this condition includes A. metronidazole (Flagyl) 500 mg twice a day for 7 days. B. conjugated vaginal estrogen cream externally every day for 1 week. C. rewashing undergarments without fabric softener and applying petroleum jelly to the affected area. D. rewashing undergarments without fabric softener and applying corticosteroids to the affected area.

Answer D - rewashing undergarments without fabric softener and applying corticosteroids to the affected area. Elimination of the offensive agent and use of corticosteroids is the treatment of choice for reactive vaginitis. An antifungal agent needs to be administered for candidiasis, and topical estrogen is used for atrophic vaginitis. No treatment or povidone-iodine is used for normal cervical or vaginal-discharge vaginitis.

Emergency contraception refers to A. an induced abortion in an emergency room (ER). B. quickly starting on birth control pills in anticipation of sexual intercourse. C. having a medroxyprogesterone (Depo-Provera) injection in the ER every 12 weeks. D. taking emergency contraceptive pills (ECPs).

Answer D - taking emergency contraceptive pills (ECPs). Emergency contraception or emergency birth control refers to keeping a woman from getting pregnant when she has had unprotected sex. Depending on when they are taken, the pills work by keeping the egg from leaving the ovary, by keeping the sperm from meeting the egg, or by keeping a fertilized egg from attaching to the uterus. They must be taken within 5 days of unprotected sex in order to work. There are two types of emergency contraception pills. Plan B is a progestin-only pill taken for the purpose of emergency contraception. One pill is taken immediately; the next is taken 12 hours later. In the second type, a higher dose of regular birth control pills is taken. The number of pills is different for each brand and, again, one dose is taken immediately and the second dose is taken 12 hours later. Plan B is sold over the counter to women older than the age of 18 without a prescription.

When prescribing the contraceptive patch (Ortho Evra®) or vaginal ring (NuvaRing®), the nurse practitioner (NP) considers that: A. these are progestin-only products. B. candidates include women who have difficulty remembering to take a daily pill. C. there are significant drug interactions with both products. D. contraceptive efficacy is less than with COC.

B. candidates include women who have difficulty remembering to take a daily pill.

The most common reasons for discontinuing combined oral contraception use is breakthrough bleeding and: A. nausea/vomiting. B. inconvenience of use. C. cost. D. high failure rate.

B. inconvenience of use.

Women with PID typically present with all of the following except: A. dysuria. B. leukopenia. C. cervical motion tenderness. D. abdominal pain.

B. leukopenia.

When considering the use of self-administered DMPA (Depo-subQ®), the NP acknowledges all of the following except: A. a self-injection is given every 3 months. B. there is no risk of bone loss with long-term use of this DMPA formulation. C. can be started immediately postpartum. D. contains a smaller amount of active ingredient than the intramuscular (IM) formulation.

B. there is no risk of bone loss with long-term use of this DMPA formulation.

You see a 34-year-old woman who reports having unprotected sexual intercourse 5 days ago and requests emergency contraception. She has a current history of mucopurulent cervicitis. The most acceptable and effective option in this clinical scenario is: A. progestin-only emergency contraception. B. ulipristal. C. Cu-IUD. D. none, as 5 days is too long to wait for emergency contraception to be effective.

B. ulipristal.

According to the United States Medical Eligibility Criteria (US MEC) for Contraception Use, indicate the appropriate US MEC category for a 37-year-old woman who smokes 10 cigarettes per day for combined hormonal contraceptives (i.e., combined oral contraceptive, patch, or vaginal ring). A. Category 1 B. Category 2 C. Category 3 D. Category 4

C. Category 3

Which of the following findings is most consistent with vaginal discharge during ovulation? A. dry and sticky B. milky and mucoid C. stringy and clear D. tenacious and odorless

C. stringy and clear

According to the United States Medical Eligibility Criteria (US MEC) for Contraception Use, indicate the appropriate US MEC category for a 45-year-old woman with history of migraine with aura for combined hormonal contraceptives (i.e., combined oral contraceptive, patch, or vaginal ring). A. Category 1 B. Category 2 C. Category 3 D. Category 4

D. Category 4

According to the United States Medical Eligibility Criteria for Contraception Use, indicate the appropriate US MEC category for a 45-year-old woman with fibroids with uterine cavity distortion for a Cu-IUD or LNG-IUD. A. Category 1 B. Category 2 C. Category 3 D. Category 4

D. Category 4

The presence of an adnexal mass in the woman with PID most likely indicates the presence of: A. uterine fibroids. B. an ectopic pregnancy. C. ovarian malignancy. D. a tubo-ovarian abscess.

D. a tubo-ovarian abscess.

An 18-year-old woman requests emergency contraception after having unprotected vaginal intercourse approximately 18 hours ago. Today is day 12 of her normally 27- to 29-day menstrual cycle and she has no contraindications to the use of any currently available forms of emergency contraception. You advise her that: A. emergency hormonal contraception use reduces the risk of pregnancy by approximately 33%. B. all forms of emergency contraception must be used within 12 hours after unprotected intercourse. C. the likelihood of conception is minimal. D. insertion of a copper-containing intrauterine device (Cu-IUD) offers an effective form of emergency and ongoing contraception.

D. insertion of a copper-containing intrauterine device (Cu-IUD) offers an effective form of emergency and ongoing contraception.

When comparing the etonogestrels, it is important to note that Nexplanon®: A. has a higher concentration of progestin. B. is effective for a longer period of time compared with Implanon®. C. can be self-administered. D. is visible on x-ray.

D. is visible on x-ray.

Women with bacterial vaginosis typically present with: A. vulvitis. B. pruritus. C. dysuria. D. malodorous discharge.

D. malodorous discharge.

For the woman with a history of DVT who is having significant vasomotor symptoms, which of the following can be can be used for symptom management? A. 17β-estradiol patch B. drospirenone C. estrone. D. paroxetine.

D. paroxetine.

With the use of a LNG-IUD (Mirena®, Skyla®), a form of long-acting reversible contraceptive (LARC), which one of the following is normally noted? A. endometrial hyperplasia B. hypermenorrhea C. increase in PID rates D. reduction in menstrual flow

D. reduction in menstrual flow

Which of the following is most consistent with a woman with PID? A. temperature 99.6°F (37.6°C); white blood count (WBC) 8,000/mm3 B. temperature 101.4°F (38.6°C); WBC 6,000/mm3 C. temperature 99.0°F (37.2°C); WBC 14,000/mm3 D. temperature 101.5°F (38.6°C); WBC 16,000/mm3

D. temperature 101.5°F (38.6°C); WBC 16,000/mm3